Emergency Medical Technician Course Listing

Spring/Summer 2015
Phone (718) 333-CARE (2273)
www.emergencycareny.com

EMERGENCY CARE PROGRAMS

EMT Refresher
REGISTRATION FORM
To register for one of the EMT Refresher courses listed below, please mark the box next to the
course that you are registering for and complete the information at the bottom of this form. Mail
this completed registration form and the $195.00 non-refundable registration fee (payable to
Emergency Care Programs by check or money order only) to:

ADDRESS:
Emergency Care Programs
th
872 East 29 Street
Brooklyn, NY 11210

R5502*

ECP Bklyn Location

6715 Bay Parkway

Start Date: 04/14/15

End Date: 07/16/15

R5503*

ECP Bklyn Location

6715 Bay Parkway

Start Date: 09/01/15

End Date: 12/17/15

Tuesday, Thursday
& 4 Mondays
6:00pm 10:00pm

Tuesday, Thursday
6:00pm 10:00pm
*Pending NYS DOH approval

Name:
Address:
City:

State:

Phone : Day: (
Other: (

Evening: (

Zip:
)

E-mail:
EMT #:

For Office Use Only:

Date
Received:
Form of
Payment:

Amount:

CASH

CK# __________________

MO# ________________________________